Aktueller Stand der Prostataarterienembolisation (PAE) zur Behandlung der benignen Prostatahyperplasie (BPH)

Zusammenfassung

Die Prostataarterienembolisation (PAE) hat sich in den vergangenen Jahren als minimalinvasive Option zur Behandlung der benignen Prostatahyperplasie (BPH) etabliert. Ziel dieser Übersichtsarbeit ist eine zusammenhängende Darstellung der technischen Grundlagen, der Patientenselektion, der klinischen Wirksamkeit, der Sicherheit, der gesundheitsökonomischen Aspekte und der Leitlinienempfehlungen. Prospektive Studien und Metaanalysen zeigen eine signifikante Reduktion von Lower Urinary Tract Symtoms (LUTS), eine Verbesserung der Lebensqualität und eine relevante Volumenreduktion der Prostata. Im Vergleich zu TUR-P und HoLEP ist die Steigerung des maximalen Harnflusses moderater, während periinterventionelle Risiken geringer ausfallen und der Erhalt der antegraden Ejakulation häufiger gelingt. Die Reinterventionsrate ist im mittleren Verlauf höher, was bei der Beratung berücksichtigt werden sollte. Für Patienten mit großem Drüsenvolumen, relevanter Komorbidität oder unter Antikoagulation stellt die PAE eine attraktive, organerhaltende Alternative dar. Technisch kommen nicht-resorbierbare Partikel (100–500 µm) sowie – in selektierten Zentren – flüssige Embolisate zum Einsatz; letztere (z.B. Glubran) erweitern das Spektrum, bedürfen jedoch weiterer klinischer Evaluation. Die Durchführung in erfahrenen Zentren mit Cone-Beam-CT-gestützter Navigation (CBCT), standardisierten Protokollen und interdisziplinärer Entscheidungsfindung reduziert die Risiken und verbessert die Ergebnisse. Insgesamt ergänzt die PAE das therapeutische Arsenal der Behandlung der BPH sinnvoll; der künftige Stellenwert hängt von belastbaren Langzeitdaten, standardisierter Technik und der präziseren Positionierung in Leitlinien ab.

Abstract

Prostatic artery embolization (PAE) has become established as a minimally invasive treatment option for benign prostatic hyperplasia (BPH) in recent years. This review aims to provide a coherent overview of the technical principles, patient selection, clinical efficacy, safety, health-economic aspects, and guideline positioning. Prospective studies and meta-analyses demonstrate a significant reduction in lower urinary tract symptoms, improvements in quality of life, and relevant prostate volume reduction. Compared with TUR-P and HoLEP, gains in maximum urinary flow are more moderate, whereas periprocedural risks are lower and preservation of antegrade ejaculation is more frequently achieved. Mid-term reintervention rates are higher and should be addressed during patient counseling. PAE is particularly attractive for patients with large prostate volumes, relevant comorbidities, or ongoing anticoagulation. From a technical perspective, non-resorbable particles (100–500 µm) are commonly used, while liquid embolic agents (e.g., Glubran) are employed in selected centers and require further clinical evaluation. Performing PAE in experienced centers with CBCT-guided navigation, standardized protocols, and interdisciplinary decision-making reduces procedural risks and improves clinical outcomes. Overall, PAE meaningfully complements the therapeutic armamentarium for BPH; its future role will depend on robust long-term data, a standardized technique, and more precise positioning within clinical guidelines.

Schlüsselwörter

Prostataarterienembolisation - benigne Prostatahyperplasie - minimalinvasive Therapie

Keywords

benign prostatic hyperplasia - minimally invasive therapy - prostatic artery embolization

Publication History

Received: 12 September 2025

Accepted after revision: 08 January 2026

Article published online:
17 February 2026

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